Risky Business: Working with Compulsive and Self-endangering Behaviours with Trauma Survivors

Presented by John Briere, Ph.D.

Thursday, November 14, 2019 – Friday, November 15, 2019  |  Richmond, bc

Date & Location

Survivors of trauma and early attachment disturbance are at elevated risk of a variety compulsive and self-endangering behaviors, ranging from suicidality and self-injury to substance abuse, indiscriminate sexual activities, and binge eating. Many of these difficulties are seen as symptoms of a personality disorder, behavioural addiction, or impulse control disorder. However, emerging research indicates that they are more accurately understood as coping/homeostatic responses to triggered childhood memories and inadequate emotional regulation capacities.

Calling on his upcoming book Triggered: An Integrated Approach to Trauma, Attachment Disturbance, and Risky Behavior (Guilford), John Briere presents an innovative, integrated approach to self-endangering behaviour, the compensatory avoidance model. Drawing on new research on memory reconsolidation, implicit processing, and revisions to habituation theory, this treatment system directly targets the memory/dysregulation dynamic, with interventions such as emotional regulation training; mindfulness, metacognitive awareness, and emotion surfing procedures; sequential memory processing; in vivo treatment of implicit memory activations; and harm reduction.

A new treatment component, trigger management, increases client autonomy, resilience, and problem-solving. Approaches to three risky behaviours will be presented in detail: self-injury, risky sexual behaviour, and bingeing and purging. Attendees will be provided with newly developed worksheets and assessment instruments that organize and inform the treatment process.

Recommended Reading

Who Should Attend

Clinical Professionals: All mental health professionals including, but not limited to Clinical Counsellors, Psychologists, Psychotherapists, Social Workers, Nurses, Occupational Therapists, Hospice and Palliative Care Workers, School Counsellors, Youth Workers, Mental Health Workers, Addiction Specialists, Marital & Family Therapists, Speech Language Pathologists, Vocational Rehabilitation Consultants and all professionals looking to enhance their therapeutic skills.

Agenda

Day 1

Why self-endangering behaviour

• Traditional models
• Borderline Personality disorder, impulse control disorder(s), and behavioural addictions
• Another (evidence-based) view: The Compensatory Avoidance Model (CAM)
• Effects of childhood trauma and attachment disturbance
• Fear structures, trauma schema, and conditioned emotional responses
• Emotional dysregulation
• Functions of Distress Reduction Behaviours (DRBs)

An overview of specific DRBs

• Self-injury, risky sexual behaviour, bingeing and purging, reactive aggression, triggered suicidal behaviour, problem gambling, compulsive stealing, problematic internet use, compulsive buying, fire setting, hair pulling and skin picking
• Non-DRBs that nevertheless involve maladaptive coping

Assessing DRB in context

• Immediate risks and comorbidities
• New assessment tools
• Review of Distress Reduction Behaviours (R-DRB)
• Function of Distress Reduction Behaviours (F-DRB)

Memories-to-Triggers Worksheet (MTW)

Safety, stabilization, and harm reduction

• Environmental safety and stability
• Safety from self-harm
• Reducing the destabilizing effects of triggered states
• Proactive resilience
• Mitigating triggered distress
• Harm reduction strategies

Acceptance and mindfulness

• Settling, metacognitive awareness, and letting go
• Urge and emotion surfing
• Mindfulness applications of DRBs
• A hybrid approach

Day 2

Trigger Management

• Psychoeducation on triggers
• Identification: Direct and indirect
• Trigger linkage
• Intervening in triggered states
• Actions that immediately address triggered responses
• Positive self-talk and metacognitive statements
• Counter-behaviours
• Pre-and post-trigger activities that decrease reactivity

RAINing for DRBs

• Recognize
• Allow
• Investigate
• Non-identify

Processing trauma-and-attachment-related memories

• Emotional processing
• Fear structure and trauma schema
• What happened to habituation and how does this change?
• Counter-conditioning
• Implications of new reconsolidation research
• Multiple memory targets: Sequential processing
• Processing explicit versus implicit memories
• Explicit → implicit
• Direct implicit
• In vivo processing of implicit memory
• Steps of processing
• Pre briefing
• Exposure
• Activation
• Disparity/new information
• Counter-conditioning/extinction
• Debriefing/closure

Intervening in three forms of compensatory avoidance

• Self-injury
• Risky sexual behaviour
• Food bingeing and purging

Learning Objectives

1. Describe the Compensatory Avoidance Model (CAM)
2. List four different distress reduction behaviours
3. Outline the central components of trigger management
4. Discuss the limitations of prolonged exposure and habituation
5. Describe two ways in which implicit processing occurs in CAM-based therapy

Your Presenter

John Briere, Ph.D.

John Briere, Ph.D., is an Associate Professor of Psychiatry and Psychology at the Keck School of Medicine, University of Southern California, and Director of the USC Adolescent Trauma Training Center of the National Child Traumatic Stress Network.  A past president of the International Society for Traumatic Stress Studies, he is recipient of the Award for Outstanding Contributions to the Science of Trauma Psychology from the American Psychological Association, the Robert S. Laufer Memorial Award for Scientific Achievement from ISTSS, and the William N. Friedrich Award for Outstanding Contribution to the Field of Child Psychology, from the Mayo Clinic.  He is author or co-author of over 120 articles and chapters, 15 books, and 9 trauma-related psychological tests. At USC, he teaches and consults in the burn unit, inpatient psychiatry, and emergency services.

 

Testimonials

“Dr. Briere engages very well with diverse audiences. John’s presentation skills are exceptional and I am grateful that he draws on stories, humour & everyday clinical experiences to connect with clinicians taking this workshop.”
– Dr. Jassal | Vancouver, BC | May 29-30, 2017

 

“Dr. Briere is an easy-to-listen to speaker. His knowledge is wide and he conveys it well. Humour helps a sometimes difficult topic. I am very glad I came to this workshop! Thank you.”
– Leana Brady-Algor | Vancouver, BC | May 29-30, 2017

 

“Very knowledgeable speaker, relatable with a great presence. I’m leaving this workshop with an understanding/working knowledge of complex trauma. More focus/time on strategies @ the end would have been helpful.”
– Edmonton, AB | May 31-June 1, 2017

 

“This training was great, helped provide me concrete ways to deal with trauma – but in a way that feels good for me (compassion, safety and letting the client lead). Additionally, it validated techniques I was already using! Thanks.”
– Edmonton, AB | May 31-June 1, 2017

 

“Thank you. Very informative and excellent presentation style.”
– Edmonton, AB | May 31-June 1, 2017

 

Registration & Fees